Outcome and surgical strategy in bronchial carcinoid tumors: single institution experience with 252 patients

• Published in: European journal of cardio-thoracic surgery 2007-02, Vol.31 (2), p.186-191
• Main Authors: Rea, Federico, Rizzardi, Giovanna, Zuin, Andrea, Marulli, Giuseppe, Nicotra, Samuele, Bulf, Renato, Schiavon, Marco, Sartori, Francesco
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Bronchial Neoplasms - mortality; Bronchial Neoplasms - pathology; Bronchial Neoplasms - surgery; Bronchoscopy; Carcinoid tumor; Carcinoid Tumor - mortality; Carcinoid Tumor - secondary; Carcinoid Tumor - surgery; Child; Epidemiologic Methods; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Pneumonectomy - adverse effects; Pneumonectomy - methods; Prognosis; Sleeve resection; Surgery; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2006.10.040

Objective: To evaluate type of surgery, long-term survival and factors influencing outcome in pulmonary carcinoid tumors. Patients and methods: We reviewed data of 252 patients who underwent surgery for carcinoid tumor in 1968–1989 (Group A) and in 1990–2005 (Group B). All cases were reviewed and classified as typical (TC) or atypical carcinoid (AC) according to WHO criteria (1999). Results: There were 174 (69%) patients with TC (167 N0, 6 N1 and 1 N2) and 78 (31%) with AC (56 N0, 13 N1, 9 N2). Surgery consisted of 163 (64.7%) formal lung resections (121 lobectomies, 18 bilobectomies, 14 segmentectomies, 10 pneumonectomies), 76 (30.1%) sleeve or bronchoplastic resections and 13 (5.2%) wedge resections. No perioperative mortality occurred, 17 (6.7%) patients experienced complications. Overall 5, 10 and 15-year survival rate was 90%, 83% and 77%. TC showed a more favourable prognosis than AC (10-year survival rate 93% and 64%; p = 0.00001) as well as N0 patients in comparison with N1-2 patients (10-year survival rate 87% and 50%; p = 0.00005). Group A received lymph-node sampling, Group B received a systematic lymphadenectomy. No difference was found between Group A and B in detection of nodal metastases (10.9% versus 11.9%; p = 0.79), but in Group A we observed 2 lymph-node relapses. In Group B number of sleeve resections significantly increased (2.7% versus 20.4%; p = 0.0001) and number of pneumonectomies showed a significant reduction (7.2% versus 1.4%; p = 0.01). Conclusions: Typical histology and N0 status were important prognostic factors in carcinoid tumors. Parenchyma-sparing procedures must be considered the treatment of choice with systematic lymphadenectomy.